Median Raphe Cyst: Types, Diagnosis & Treatment of Midline Genital Lesions in Males

Mayta
May 2
2 min read

Updated: May 5

Introduction

Median raphe cysts are benign, congenital lesions that form anywhere along the midline raphe of the male genitalia — from the meatus of the penis, along the scrotum, down to the perineum. They develop from trapped epithelial tissue during embryogenesis and are often unrecognized until adolescence or adulthood.

🔬 Pathophysiology

During embryonic development, incomplete closure or epithelial fusion along the urethral and scrotal midline can result in epithelial-lined cysts. These remain silent and slowly grow, sometimes forming visible or palpable nodules.

👀 Clinical Morphological Types

Based on the illustration provided, median raphe cysts can appear in different forms:

1. 🔹 Solitary Cyst

Presentation: A single, small, dome-shaped, yellowish or skin-colored nodule.
Common site: Scrotal or penile midline.
Typical concern: Cosmetic appearance or occasional discomfort.
Key Feature: Non-tender, non-inflammatory, may be compressible.

2. 🔸 Multiple Cysts

Presentation: Several cystic nodules distributed in a segmental line along the raphe.
Clinical significance: Rare but notable for possible irritation from clothing or friction.
Key Feature: Separate small nodules that may appear simultaneously or sequentially.

3. 🔹 Cordlike Lesion

Presentation: A linear or sausage-like swelling along the raphe, composed of coalescing small cysts.
Commonly mistaken for: Epidermal inclusion cyst chain or penile lymphangiectasia.
Key Feature: Rope-like, soft to firm texture, non-tender unless secondarily infected.

⚠️ Important Clinical Points

✅ Positive Findings:

Midline location (unique feature).
Soft, cystic, mobile, non-painful lesion.
No erythema or warmth unless infected.

❌ Negative Findings:

No redness or swelling unless infected.
No fever, systemic signs.
No lymphadenopathy.

🔍 Differential Diagnosis

Condition	Differences from MRC
Epidermoid cyst	Often lateral; filled with keratin.
Furuncle	Painful, red, pus-filled.
Hydrocele	Fluctuant, transilluminates, not midline.
Sebaceous cyst	May be midline but more common elsewhere.
Scrotal abscess	Fluctuant, painful, febrile.

🧪 When to Investigate

Ultrasound (USG): To confirm fluid-filled nature and rule out vascular lesion.
Swab culture (if discharge present): To rule out infection.
Biopsy (rare): If diagnosis unclear or rapid growth.

🛠️ Management

Status	Approach
Asymptomatic	Observation and reassurance. No intervention needed.
Symptomatic	Surgical excision (curative). Local anesthesia is usually sufficient.
Infected	Warm compresses ± antibiotics. Avoid I&D unless necessary. Surgical excision later.

📋 Patient Advice

Do not scratch or squeeze it like a pimple! Squeezing may cause the secondary infection. The best management if it grows or becomes bothersome is surgical excision.

✅ Take-home Messages

Median raphe cysts are benign, congenital, and usually painless.
Three main types: solitary, multiple, and cordlike.
Surgery is not always needed — only if infected, enlarging, or cosmetically bothersome.
Avoid manipulation to prevent inflammation or secondary infection.